Unfortunately, Medicare doesn’t cover most routine dental care, procedures, or supplies; however, certain dental procedures are covered when you’re in a hospital or if the procedure is deemed medically necessary.

It’s important to maintain proper dental care and hygiene throughout your life, but as you get older, oral surgery or other dental procedures may be necessary to fix issues or pain, or even diagnose more severe medical issues. However, according to the National Institute of Dental and Craniofacial Research, about one in four seniors ages 65+ have gone five years or more since their last dental visit.

If you are eligible for Medicare, you have options to help with the cost of dental procedures or oral surgery. There are a number of exclusions and exceptions to be aware of, so understanding what is and is not covered can help determine how much you will pay out-of-pocket.

Does Medicare pay for oral surgery?

If oral surgery is deemed medically necessary and is performed by a Medicare-participating doctor or surgeon, it may be covered by Medicare.

Examples of covered oral surgery may include:

• Part of a treatment plan for certain medical conditions, such as cancer or heart disease.
• Part of a covered procedure, like reconstruction of your jaw after an injury.
• Oral exams prior to a heart valve replacement or kidney transplant.
• Tooth extraction prior to radiation treatments.
• Jaw reconstruction after removal of a tumor.
• Surgery to treat fractures of the face or jaw, including wiring or dental splints.

In these cases, oral surgery would be covered either by Medicare Part A or Part B.

Part A Coverage: If you are an inpatient in a hospital and need to have an emergency or dental procedure, and the procedure is completed by a Medicare-approved dentist on the hospital's staff, the procedure will likely be covered. This includes if you’re treated in:

• Acute care hospital
• Critical access hospital
• Inpatient rehabilitation facility
• Long-term care hospital
• Inpatient care as part of a qualifying research study
• Mental health care

Medicare will cover some costs if you require a dental-related hospitalization, such as room and board, anesthesia and x-rays. However, it still will not cover dental services excluded from Original Medicare coverage, such as dentures.

Part B Coverage: If the oral surgery is performed by a physician and meets certain qualifying criteria, it may be covered by Medicare. Outpatient diagnostic tests or services or may also be covered, as well as exams prior to a kidney transplant or heart valve replacement.

Medicare Part D drug coverage would also kick in and cover any approved medications that are prescribed to you before or after a dental procedure.

To ensure your dental procedure or oral surgery is covered, verify with your provider, with Medicare or your Medicare Advantage or dental plan prior to the procedure to make sure you don’t get charged and have to pay out-of-pocket. Ask your surgeon if they participate in Medicare, and if they can estimate the cost of the surgery and your out-of-pocket costs.

What is oral surgery?

Risk for conditions such as gum disease and oral cancer increase as you get older. Typically, if your regular dentist finds something that requires oral surgery, they will refer you to an oral surgeon or specialist. This surgeon can perform tooth extraction, jaw surgery, dental implants, or biopsies if necessary.

Oral surgery can include dental procedures for issues affecting your teeth, gums, jaw and even facial bones. There are three most common circumstances you may need to see an oral surgeon:

• Tooth Extraction: While your regular dentist can usually perform tooth extractions (or tooth removals), you may need to be referred to an oral surgeon for complex extractions or wisdom tooth removal.
• Corrective Surgery: If you have been in an accident and have fractures in your face or jaw, you may require wiring or dental splints to help you heal properly. An oral surgeon can help with this.
• Restorative Surgery: Removing tumors from the mouth or face, and repairing or reconstructing the area, can be done by an oral surgeon.

Does Medicare cover tooth extractions?

In most cases, Medicare does not cover tooth extractions unless it’s considered medically necessary by a Medicare-approved oral surgeon. Removal of teeth, diseased teeth in a jaw with an infection, or to prepare for dentures, is also not covered.

If you have a disease involving the jaw and a tooth extraction is necessary due to the disease, Original Medicare may cover the removal.

Note: If you have a Medicare Advantage plan, tooth extractions may be covered with routine dental coverage.

Does Medicare cover gum surgery?

In most cases, Medicare does not cover gum surgery (unless it’s considered medically necessary by a Medicare-approved oral surgeon).

Sometimes, surgery may be necessary to treat certain types of gum disease, such as gingivitis or periodontitis (an infection of the soft tissue that holds your teeth in place). Depending on how severe or advanced the infection or disease is, your dentist may recommend surgery, which can help remove disease and reinstate the health of your gums.

Typically, gum surgery is not part of a covered procedure or treatment plan.

Does Medicare cover wisdom teeth removal?

In most cases, Medicare does not cover wisdom teeth removal (unless it’s considered medically necessary by a Medicare-approved oral surgeon).

Wisdom teeth are the last teeth to appear in your mouth, found the farthest back. Sometimes, wisdom teeth become impacted, or stuck, and they grow at an odd angle, causing complications. Other times, wisdom teeth don’t form or grow in at all. When wisdom teeth cause problems, such as pain, they may need to be removed. They can also cause damage to other teeth, including moving them around.

Usually, wisdom teeth come in when you’re between the ages of 17-25. After that, if you haven’t had issues or pain, you likely never will.

How much does oral surgery cost through Medicare?

If you receive covered oral surgery under Medicare Part A, you will be required to first meet the Part A deductible, which is $1,632 in 2024. Part A, of course, only applies for inpatient care. If you have your oral surgery as an outpatient (as most people do), Medicare Part B will apply instead. In this case, you must meet the Part B annual deductible of $240 (in 2024).

Once your deductibles are met, or if you’ve met them prior to the surgery, you will typically pay an additional 20% of the Medicare-approved amount of the surgery or procedure. Medicare will cover the other 80%.

It’s important to make sure you’re receiving oral surgery from a Medicare-approved, participating provider. This means the provider has agreed to accept the Medicare-approved amount as payment for service they provide. If you do not receive surgery from an approved, participating provider, you may be required to pay more out-of-pocket, even up to 100% of the cost.

For an approved procedure, your specific out-of-pocket cost may vary. This especially depends on what the particular procedure is and if you will require prescription drugs following the procedure.

What dental care is not covered by Medicare?

Original Medicare Parts A and B do not cover dental care or oral surgery performed primarily for tooth health. Care not covered includes:

• Oral exams
• Cleanings
• Fillings
• Tooth extractions (in some cases)
• Dentures
• X-rays
• Root canals
• Dental plates
• Other dental devices such as crowns, bridges and implants

Medicare will not cover oral surgery that is intended to treat teeth, such as installing bridges, crowns or dentures. If you don’t have additional dental insurance or Part C coverage, you will pay entirely out-of-pocket for non-covered services.

It’s important to note that even if your oral surgery or dental procedure is covered, Medicare will likely not pay for follow-up dental care after the health condition has been treated.

Do Medicare Advantage Plans cover oral surgery?

Some Part C (Medicare Advantage) plans offer benefits above and beyond Original Medicare. This may include dental coverage, such as cleanings, fillings, X-rays and other dental procedures. Some plans may also include coverage for dentures. Talk with your plan to learn more information.

Can I get a stand-alone dental plan?

Yes, you have the option of purchasing a separate, stand-alone dental plan to cover services not covered under Original Medicare. Dental insurance is typically provided by private insurance companies, but they can be expensive. If you are considering purchasing a separate dental plan, be sure it includes coverage for:

• Preventive, diagnostic and emergency services.
• Basic restorative dental care (fillings, root canal, periodontal treatment, etc.)
• Major restorative dental care (crowns, bridges, dentures, etc.)

Learn more about Dental Vision Hearing insurance.

Additional resources

• ClearMatch Medicare: Find a Medicare Plan
• Medicare.gov: Costs
• Social Security Administration: Extra Help